International Journal of Public Health

, Volume 63, Issue 1, pp 93–103 | Cite as

The education gradient in cancer screening participation: a consistent phenomenon across Europe?

  • Barbara WillemsEmail author
  • Piet Bracke
Original Article



To extend the literature on educational inequalities in cancer screening participation (1) by simultaneously focusing on participation in screening for cervical, breast and colorectal cancer across 27 European countries and (2) by statistically testing whether these educational inequalities vary according to country-specific screening strategies: organised or opportunistic.


Self-reported data from Eurobarometer 66.2 (2006) on cancer screening participation in the preceding 12 months were used to outline cross-national variations in screening strategies, target populations and participation rates. Multilevel logistic regressions were applied.


Individuals with higher levels of education were more likely to participate in screening for cervical, breast and colorectal cancer than were those with less education. Educational inequalities were significantly smaller in countries with organised cervical cancer screening than they were in countries with opportunistic screening (OR = 0.716, 95% CI 0.549–0.935). The same interaction was observed for participation in screening for breast and colorectal cancer, albeit with marginal significance.


This study clearly highlights the crucial role of educational level in the likelihood of participating in cancer screening. Countries can reduce educational inequalities by applying organised screening programmes.


Cancer screening participation Cancer screening strategy Educational inequalities Comparative health research Europe 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Statement on the welfare of animals

This article does not contain any studies involving human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Swiss School of Public Health (SSPH+) 2017

Authors and Affiliations

  1. 1.Ghent UniversityGhentBelgium

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